Management and outcomes of anterior skull base fractures with cerebrospinal fluid leak

Objectives: The objective of the study is to report our experience in managing ASBF with CSF leakage in a resource-limited setting. Materials and Methods: This retrospective study included 43 patients diagnosed with ASBF and CSF leakage at Donka National Hospital between January 2015 and December 2021. Data were collected from the patient files, operative reports, and imaging studies. Clinical presentation, injury mechanism, imaging results, treatment, and outcomes were analyzed. Statistical analyses were performed using descriptive and analytic methods. Results: The mean age of the participants was 38 ± 12 years (65% male). The injury mechanisms included road traffic accidents (70%), falls (25%), and assaults (5%). Acute rhinorrhea (74%) and delayed leaks (12%) were the most common presentations. Meningitis was observed in 28% of cases. The diagnosis was clinical in 14% of patients, while 80% underwent computed tomography scans. Fractures were classified using the Fain and Peri system. The antibiotics used were ampicillin (86%) and ceftriaxone (14%). Surgical intervention (58%) had a mean 5-day delay, and 32% occurred >7 days after the decision. The overall mortality rate was 14%. Mortality predictors included Glasgow Coma Scale score ≤8 (odds ratio OR = 4.8) and meningitis (OR = 3.6). At the 12-month follow-up, 64% of the surgical group had an excellent outcome, with complete resolution of the leak. Conclusion: ASBF with CSF leakage in Guinea presents significant challenges, including delayed care and limited resources. Early diagnosis and timely surgical intervention are crucial for improving outcomes. Improvements in pre-hospital care, antibiotic access, and endoscopic training are critical.